Study Finds Psychotropic Drugs Overused In Foster Kids

A just-released federal study finds that psychotropic drugs are being overused in foster kids. According to the study, foster children on Medicaid are receiving psychotropic medications—including antipsychotics and antidepressants—much more than other children covered by Medicaid.

The Government Accountability Office (GAO) study has lawmakers and medical experts worried that physicians are over-prescribing the powerful drugs to treat children in the foster care system, said The Wall Street Journal. The children, wards of the state who are temporarily placed in homes pending permanent living environments, often have emotional challenges and come from difficult past, and some are being dosed at very high levels.

Also, for the most part, children in the Medicaid system can be overmedicated since they are typically seen by general practitioners, not counselors, the Journal explained. “The high-risk practices identified by the GAO study raise significant concerns regarding the treatment of severely mentally ill and vulnerable youth,” child psychiatrist Jon McClellan, University of Washington, said, the Journal reported.

In cases in which drug amounts exceeded a child’s maximum dose amount, by age, children were, more often than not, foster children, versus Medicaid-insured children from lower income environments, the Journal pointed out. The GAO report, submitted as part of a Senate hearing, revealed that foster children were several times likelier to be taking five or more psychotropic drugs at once, versus other Medicaid kids, said the Journal. This study focused on Medicaid programs in Florida, Massachusetts, Michigan, Oregon, and Texas in 2008 and revealed that 1,752 children in those states’ Medicaid programs were being treated with five or more such drugs at the same time.

Antipsychotics, including Abilify and Risperdal, antidepressants such as Cymbalta and Paxil, and attention-deficit hyperactivity-disorder drugs such as Ritalin and Stratter, were analyzed. The GAO found that foster children were 2.7-4.5 times likelier to be treated with psychotropics versus non-foster youngsters in Medicaid, said the Journal.

“There is no evidence for use of five mind-altering medications in an adult, let alone a child,” said Senator Tom Carper (Democrat-Delaware), according to the Journal; Senator Scott Brown (Massachusetts-Republican) called the findings “shocking.” Bryan Samuels, a senior official overseeing Medicaid at the federal Department of Health and Human Services, said that “the current use of psychotropic medications among children, particularly children in foster care, goes beyond that which is supported by empirical research,” the Journal reported. Samuels said his department just wrote to state Medicaid agencies “to raise awareness of these issues.”

Antipsychotics are approved for serious psychiatric conditions, such as schizophrenia and bipolar disorder; however, they are often used off-label to treat vulnerable populations, such as seniors with dementia—and now, children—despite that while atypical antipsychotics are being used more and more for an array of off-label conditions, the drugs are only effective for a few such diagnoses. Drugs can be prescribed at physician discretion and these drugs, in particular, are being used to treat a range of disorders. Some of these other uses have seen recent approval by the U.S. Food and Drug Administration (FDA); many have not.

For instance, another study reviewing prior Zyprexa, Abilify, Risperdal, and Seroquel research suggests that while atypical antipsychotics are used for a number of off-label diagnoses, the drugs are not effective for most and there is a variance in benefits and adverse reactions, according to a prior Journal of the American Medical Association (JAMA) article.